Short- and Long-term Outcomes After Hemihepatectomy for Perihilar Cholangiocarcinoma: Does Left or Right Side Matter?

Overview

Journal Hepatobiliary Surg Nutr

Publisher AME Publishing Company

Date 2021 Apr 26

PMID 33898556

Citations 11

Authors

Lotte C Franken

Pim B Olthof

Joris I Erdmann

Otto M van Delden

Joanne Verheij

Marc G Besselink

Olivier R Busch

Thomas M van Gulik

Affiliations

Soon will be listed here.

Abstract

Background: The only potentially curative option for patients with perihilar cholangiocarcinoma (PHC) is resection, typically an extrahepatic bile duct resection in combination with (extended) liver resection. Complications such as bile leakage and liver failure have been suggested to be more common after right-sided resections compared to left-sided resections, whilst superior oncological outcomes have been reported after right-sided resections. However, data on outcomes after right-sided or left-sided liver resections in PHC are scarce. Therefore, we aimed to investigate short- and long-term outcomes after left and right hemihepatectomy in patients with PHC.

Methods: In this retrospective study, patients undergoing major liver resection for suspected PHC in a tertiary center between 2000-2018 were included. Patients who had undergone left-sided resections were compared to patients with right-sided resections in terms of complications (90-day mortality, overall and severe morbidity and specific complications). For long-term outcomes, only patients with pathologically proven PHC were included in the survival analysis.

Results: A total of 178 patients undergoing hemihepatectomy for suspected PHC were analysed, including 76 left-sided and 102 right-sided resections. Overall 90-day mortality was 14% (24 out of 178), with no significant difference after left-sided resection (11%; 8 out of 76) versus right-sided resection (16%; 16 out of 102) (P=0.319). Severe morbidity (Clavein Dindo ≥3) was also comparable in both groups: 54% versus 61% (P=0.361). No differences in specific complications including bile leakage were observed, although liver failure appeared to occur more frequently after right hemihepatectomy (22% versus 11%, P=0.052). Five-year overall survival for pathologically proven PHC, excluding in-hospital mortality, did not differ; 43.7% after left-sided resection . and 38.2% after right-sided resection (P=0.553).

Conclusions: Both short- and long-term outcomes between patients undergoing left and right hemihepatectomy for PHC were comparable. Post-hepatectomy liver failure was more common after right-sided resection.

Citing Articles

Parenchyma-Preserving Hepatectomy in Perihilar Cholangiocarcinoma: A Chance for Critical Patients?.

Broring T, Wagner K, von Hahn T, Oldhafer K Visc Med. 2024; 40(2):53-60.

PMID: 38584859 PMC: 10995988. DOI: 10.1159/000537884.

Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible.

Olthof P, Erdmann J, Alikhanov R, Charco R, Guglielmi A, Hagendoorn J Ann Surg Oncol. 2024; 31(7):4405-4412.

PMID: 38472674 PMC: 11164810. DOI: 10.1245/s10434-024-15115-0.

Clinical feasibility of modified extended left hemihepatectomy in advanced perihilar cholangiocarcinoma.

Jo H, Kim D Hepatobiliary Surg Nutr. 2024; 13(1):165-167.

PMID: 38322211 PMC: 10839717. DOI: 10.21037/hbsn-23-610.

Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma.

Kawano F, Yoshioka R, Ichida H, Mise Y, Saiura A Ann Gastroenterol Surg. 2023; 7(6):848-855.

PMID: 37927920 PMC: 10623956. DOI: 10.1002/ags3.12734.

Gallbladder cancer mimicking perihilar cholangiocarcinoma-considerable rate of postoperative reclassification with implications for prognosis.

Nooijen L, Gustafsson-Liljefors M, Erdmann J, DSouza M, Gilg S, Villard C World J Surg Oncol. 2023; 21(1):286.

PMID: 37697321 PMC: 10494342. DOI: 10.1186/s12957-023-03171-x.

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